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2.
Rev Med Suisse ; 16(676-7): 59-62, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961086

RESUMO

At a time when «â€…Smarter medicine ¼ and «â€…Choosing Wisely ¼ campains become increasingly important, emergency medicine is no exception. Many recent studies lead us to reconsider our practices and to change our work-up and treatement strategies, to ultimately use only the ones with a real clinical benefit for emergency departement patients.


Assuntos
Medicina de Emergência , Medicina de Emergência/tendências , Serviço Hospitalar de Emergência , Humanos
3.
J Surg Res ; 245: 636-642, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31525629

RESUMO

BACKGROUND: Bystanders play a significant role in the immediate management of life-threatening hemorrhage. The Stop the Bleed (STB) program was designed to train lay rescuers (LRs) to identify and control life-threatening bleeding. The aim of this study was to evaluate the efficacy of STB training for rescuers from different backgrounds. We hypothesized that STB training would be appropriate to increase skills and knowledge of bleeding control techniques for all providers, regardless of level of medical training. STUDY DESIGN: Course participants anonymously self-reported confidence in six major areas. A five-point Likert scale was used to quantitate participant's self-reported performance. Results were stratified into medical rescuers (MR) and LRs. Students' ability to perform STB skills were objectively assessed using an internally validated 15-point objective assessment tool. Data were pooled and analyzed using Student's t-test and chi-Squared test with P < 0.05 considered significant. Results are presented as average with standard deviation (SD) unless otherwise stated. RESULTS: A total of 1974 participants were included in the study. Precourse confidence was lowest for both groups in management of active severe bleeding and ability to pack a bleeding wound. Postcourse confidence improved significantly for both groups in all 6 core areas measured (P < 0.001). The most significant increases were reported in the two previous areas of lowest precourse confidence-management of active severe bleeding-LRs 2.0 (SD 1.2) versus 4.2 (SD 0.9) and MRs 2.6 (SD 1.4) versus 4.6 (SD 0.6), P < 0.001-and ability to pack a bleeding wound-LR 2.1 (SD 1.3) versus 4.4 (SD 0.8) and MR 2.7 (SD 1.3) versus 4.7 (SD 0.05), P < 0.001. Objective assessment of LR skills at the end of the course demonstrated combined 99.3% proficiency on postcourse objective assessments. CONCLUSIONS: This study provides quantitative evidence that Stop the Bleed training is effective, with both LRs and MRs demonstrating improved confidence and skill proficiency after a 1-h course. Future program development should focus on building a pool of instructors, continued training of LRs, and determining how often skills should be recertified.


Assuntos
Competência Clínica , Medicina de Emergência/educação , Conhecimentos, Atitudes e Prática em Saúde , Hemorragia/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Avaliação Educacional , Feminino , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina , Adulto Jovem
4.
Emerg Med Clin North Am ; 38(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757244

RESUMO

Acute musculoskeletal injuries are commonly seen in our emergency departments, and are commonly missed. There are many reasons for more missed injures and a significant one is over-reliance on radiographs. An emergency department orthopedic assessment goes far beyond the radiographs. A focused, yet comprehensive history is vital to understand the forces and mechanism of injury. That injury must be understood in the context of the patient, because older and much younger patients have weaker bone. Finally, the physical examination is instrumental in localizing the pathology and is essential to put radiograph results in the proper clinical context.


Assuntos
Gerenciamento Clínico , Medicina de Emergência/métodos , Procedimentos Ortopédicos/métodos , Exame Físico/métodos , Radiografia/métodos , Ferimentos e Lesões/terapia , Humanos , Ferimentos e Lesões/diagnóstico
7.
Br J Radiol ; 93(1106): 20190781, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868522

RESUMO

OBJECTIVE: Sedation for pediatric patients undergoing interventional procedures in radiology is in increasing demand. Once only anesthesiology-performed, there is a demand for sedation services to perform sedations for these procedures. However, the safety of performing long sedations by non-anesthesiologists in interventional radiology has not been reported. This pilot study aimed at describing a single center's experience and outcome with sedation. METHODS: This study reviews the sedations performed at a single center by a pediatric emergency physician who performed the sedation. The results regarding safety and satisfaction were reviewed. RESULTS: A total of 52 sedations were documented. Four cases of significant adverse events and three adverse events occurred. In all cases, the procedures were completed. None of the patients required intubation or admission following the sedation. There was high satisfaction by the interventional radiologists. CONCLUSION: This small pilot study shows that sedations for procedures in interventional radiology can be performed safely and successfully by dedicated non-anesthesiology sedation services. This may be considered as an alternative when anesthesiology service is not available. ADVANCES IN KNOWLEDGE: This small, single center pilot study examines the safety of sedation by a non-anesthesiologist for interventional radiology procedures. This may offer an additional method of performing procedures in the pediatric population while anesthesia is not readily available.


Assuntos
Sedação Consciente/métodos , Medicina de Emergência/estatística & dados numéricos , Malformações Vasculares/cirurgia , Adolescente , Anestesiologistas , Criança , Pré-Escolar , Sedação Consciente/efeitos adversos , Medicina de Emergência/normas , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , Segurança do Paciente
8.
Harefuah ; 158(12): 783-786, 2019 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-31823530

RESUMO

BACKGROUND: Discharge against medical advice (DAMA) in pediatrics may endanger the child, increase the rate of complications, morbidity or mortality. Despite the prevalence of this phenomenon in the world, we found only one study that examined the DAMA phenomenon in Israel. The study examined the phenomenon in one ER in general and did not distinguish between adults and children. OBJECTIVES: To describe the characteristics of children and parents who left the ER against medical advice for hospitalization and to examine the reasons given by the parents, and factors associated with this phenomenon. METHODS: A prospective study involving parents who refused to hospitalize their children despite a medical recommendation. Data was collected from medical records and telephone interviews after discharge. RESULTS: During the study, there were 16,376 visits to the pediatric ER, 3288 recommendations for hospitalization (20.07%) and 200 DAMA (6%). Reasons for parents refusing hospitalization can be categorized according to: child's health reasons, parents personal reasons and reasons related to the health system`s function. A total of 22 of the children returned to the ER for the same complaint and 12 of them were hospitalized (7.9% of the children who completed their participation in the study). DISCUSSION: Refusal of medical care for children is a disturbing phenomenon due to the negative consequences that may result from this. In order to minimize the extent of DAMA and its damage, it is very important to recognize the extent and understand the factors associated with this phenomenon.


Assuntos
Medicina de Emergência , Hospitalização , Alta do Paciente , Recusa do Paciente ao Tratamento , Adulto , Criança , Humanos , Israel , Pais , Estudos Prospectivos
12.
Psychiatr Danub ; 31(4): 483-486, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698406

RESUMO

Emergency personnel, but also medical personnel and other assisting groups have a significantly increased risk of developing trauma disorder after extreme work-related experiences. In order to counter these, Germany offers extensive preventive measures for primary, secondary and tertiary prevention. The aim of this article is to outline the most important elements of psychosocial support for second victims. Psychoeducation is an important and effective component of these concepts. Finally, the most frequently formulated question, why conversations about critical incidents are helpful, is revisited.


Assuntos
Esgotamento Profissional/prevenção & controle , Serviços Médicos de Emergência , Medicina de Emergência , Pessoal de Saúde/psicologia , Apoio Social , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Esgotamento Profissional/psicologia , Alemanha , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia
15.
Am Surg ; 85(9): 961-964, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638507

RESUMO

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.


Assuntos
Competência Clínica , Medicina de Emergência/normas , Cirurgia Geral/normas , Ferimentos e Lesões/cirurgia , Cuidados Críticos , Medicina de Emergência/educação , Cirurgia Geral/educação , Mortalidade Hospitalar , Humanos , Tempo de Internação , Duração da Cirurgia , Avaliação de Resultados da Assistência ao Paciente , Pennsylvania , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Estados Unidos
16.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31638710

RESUMO

Emergency Medicine became a supraspeciality in Sweden in 2008. The Swedish Specialist Examination in Emergency Medicine is a formative examination that seeks to guide local training in Emergency Medicine, provide feedback to physicians during their residency, and establish national standards for various processes in Emergency Medicine. It consists of six partial examinations and 118 cases. Documents and checklists accessible on the internet specify the degree of competence expected during the examination. Program directors are tasked with offering the examination locally to their residents. During the past 10 years, the examination has been offered during 53 days to 180 residents belonging to 27 training programs. The total number of passed partial examinations is 201. Six physicians have so far passed all six partial examinations.


Assuntos
Educação de Pós-Graduação em Medicina , Avaliação Educacional , Medicina de Emergência/educação , Humanos , Especialização , Suécia
17.
Clinics (Sao Paulo) ; 74: e663, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644664

RESUMO

OBJECTIVE: To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS: A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach's alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS: The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach's alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION: The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.


Assuntos
Avaliação Educacional , Medicina de Emergência/educação , Respiração Artificial , Estudantes de Medicina , Inquéritos e Questionários/normas , Adulto , Brasil , Estudos Transversais , Medicina de Emergência/normas , Análise Fatorial , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência , Masculino , Reprodutibilidade dos Testes
19.
Harefuah ; 158(10): 635-638, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576707

RESUMO

AIMS: In our article we seek to describe the initiation of new medical specialty fields in Israel, including the different considerations in the decision-making process and recent trends. BACKGROUND: Physicians' specialization by postgraduate training and specialty certification satisfies the publics' need for high quality medical treatment, supports medical institutions confidence in their medical staff qualifications, guarantees physicians' social accountability and is also linked with positive medical results. Nevertheless, fragmentation of medicine enfolds a hazard to continuity of medical care and loss of holistic perspectives, as well as hazards of systematic malfunction such as brain drain in vital basic specialties and high costs. METHODS: Information was gathered from the protocols of relevant deliberations conducted at the Scientific Council of the Israeli Medical Association, dealing with the initiation of new medical specialty fields and from relevant regulations. Numerical data was extracted from the IMA database. The information gathered was qualitatively analyzed by Template Analysis. RESULTS: Over two decades ranging between 1999 and 2019, three new medical specialties were initiated, including Emergency Medicine (1999), Pain Relief Medicine (2008) and Palliative Medicine (2012). The initiation of two other specialties, Invasive Neuro-Radiology and Metabolic Diseases, is still under process. The field of Child Development has joined an existing specialty in Pediatric Neurology, becoming a new specialty in Pediatric Neurology and Child Development in 2008, a new route for Pediatric Emergency Medicine branched out of Emergency Medicine (2008) and a new route for Pediatric Rheumatology branched out of Rheumatology (2013). We describe the different considerations taken into account, the prerequisites to initiation and milestones of the process, including grandfathering and accreditation. CONCLUSIONS: The trend of specialization in more medical fields will probably continue in the foreseen future. It will therefore continue to challenge the Scientific Council of the Israeli Medical Association with complex decision-making regarding the initiation of new medical professions or new routes within exciting professions.


Assuntos
Médicos , Especialização , Criança , Medicina de Emergência , Humanos , Israel , Neurologia
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